An overlap-weighted analysis on 10-year survival of off-pump versus on-pump coronary artery grafting in multivessel coronary artery disease.

BACKGROUND AND OBJECTIVE: The introduction of off-pump coronary artery bypass surgery intended to overcome some of the conventional on-pump procedure limitations by avoiding potentially harmful adverse effects of extracorporeal circulation and aortic cross-clamping. However, the doubt remains on whether it is associated with worse long-term outcomes. To compare long-term survival in patients with multivessel ischemic heart disease undergoing off-pump versus on-pump coronary artery bypass grafting. METHODS: Retrospective analysis of 4788 consecutive patients undergoing primary isolated multivessel coronary artery bypass grafting surgery, performed from 2000 to 2015, in Northern Portugal. Among the study population, we identified 1616 and 3172 patients that underwent off-pump and on-pump coronary artery grafting, respectively. We employed a propensity-score-based overlap weighting (OW) algorithm to restrict confounding by indication. The primary endpoint was all-cause mortality at 10 years. RESULTS: The mean age of the study population was 63.9 (±9.8) years, and 951 (19.9%) were females. OW was effective in eliminating differences in all major baseline characteristics. Follow-up was 100% complete. The median follow-up time was 12.80 (9.62, 16.62) years. The primary endpoint of all-cause mortality at 10 years occurred in 431 patients (26.7%) in the off-pump group, as compared with 863 (27.2%) in the on-pump group (hazard ratio, 0.93; 95% confidence interval, 0.83-1.04; p = .196). CONCLUSIONS: In this longitudinal, population-level comparison of off-pump versus on-pump coronary artery bypass surgery for treating multivessel coronary artery disease, the primary outcome of long-term mortality was identical among both patients' groups.

"Periosteum: An imaging review".

Periosteum is a fibrous sheath, coating the external bone, except in the articular surfaces, tendon insertions and sesamoid bone surface¹. It changes its aspects and characteristics with aging, becoming progressively less elastic and more firm. It is composed of two different layers: outer fibrous (firm, collagen-filled) and inner proliferative (cambium, containing osteoprogenitor cells)². Four vascular systems are responsible for the blood supply of the periosteum: the intrinsic periosteal system, located between fibrous and proliferative layer; the periosteocortical, the main nutritional arteries of the periosteum; the musculoperiosteal, responsible for the callus formation after fractures; the fascioperiosteal, specifically for each bone.³ It is crucial to bone formation and resorption, reacting to insults in the cortical bone, such as tumors, infections, traumas, medications and arthritic diseases. The aggressiveness of the reaction can be suggested by its radiological aspect and appearance4. The periosteum in children is looser compared to adults, resulting in earlier and more exuberant reactions. All these aspects will be detailed, so the essential information all radiologists need to know will be discussed.

The role of magnetic resonance imaging in the evaluation of bone tumours and tumour-like lesions.

UNLABELLED: Bone tumours and tumour-like lesions are frequently encountered by radiologists. Although radiographs are the primary screening technique, magnetic resonance imaging (MRI) can help narrow the differential or make a specific diagnosis when a lesion is indeterminate or shows signs of aggressiveness. MRI can extend the diagnostic evaluation by demonstrating several tissue components. Even when a specific diagnosis cannot be made, the differential diagnosis can be narrowed. MRI is superior to the other imaging modalities in detecting bone marrow lesions and tumoral tissue (faint lytic/sclerotic bone lesions can be difficult to visualise using only radiographs). Contrast-enhanced MRI can reveal the most vascularised parts of the tumour and MRI guidance makes it possible to avoid biopsing necrotic areas. MRI is very helpful in local staging and surgical planning by assessing the degree of intramedullary extension and invasion of the adjacent physeal plates, joints, muscle compartments and neurovascular bundles. It can be used in assessing response to neoadjuvant therapy and further restaging. The post-therapeutic follow-up should also be done using MRI. Despite the high quality of MRI, there are a few pitfalls and limitations of which one should be aware. Applications of MRI in bone tumours will probably continue to grow as new sequences are further studied. TEACHING POINTS: • When a lesion is indeterminate or shows signs of aggressiveness, MRI is indicated. • When MRI does not lead to a diagnosis, biopsy is indicated. • MRI is superior to the other imaging modalities in detecting bone marrow lesions. • MRI is very helpful in local staging and surgical planning. • MRI is used in assessing the response to neoadjuvant therapy, restaging and post-therapeutic follow-up.